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They all come together and no one company does everything. If we are serious about best value, we have to consider all the providers, including in-house provision.
Is there a central perspective on how well the work is being done and on where the best practice is? There will be best practice, so let us find it and use it as a model for the future.
The balance of funds would surely still have to be spent in the best interests of the local community, therefore they would be covered by the duty of best value.
I believe that the directly elected element of the boards would add to that and would in no way be divisive or detract from a positive programme of implementing what is best for health service delivery in health board areas.